Individuals living with serious mental illness (SMI) face pervasive stigma, with damaging effects on their intimate lives. Although evidence suggests individuals might endorse stereotypes about their romantic relationships, no tool has addressed self-stigma in this domain. This study aimed to develop and validate the Intimate Relationship Self-Stigma Scale (IRSS), specifically, to determine its structural and construct validity, as well as the internal consistency and test-retest reliability. This instrument was co-constructed with peer support workers living with SMI. Using a bipolar semantic differential format, the IRSS captures both self-stigmatizing beliefs and positive self-perceptions. Items were generated through focus groups and literature review. Participants with SMI (N = 150) completed the IRSS online, along with measures of internalized stigma, self-esteem, and romantic functioning. Exploratory factor analyses supported a four-factor structure-Disclosure Effects, Self-Attractiveness, Stability, and Intimacy Needs-explaining 48.6% of the variance. Subscales demonstrated satisfactory internal consistency (ω = .69-.87), test-retest reliability (ICC = .79-.93), and expected correlations with related constructs. The IRSS fills a critical gap in recovery-oriented mental health care by providing a comprehensive assessment of internalized stigma in romantic contexts while simultaneously capturing positive self-perceptions. Further validation, including confirmatory factor analyses and cross-cultural validity, is warranted.

We captured the perspectives of 23 pregnant and parenting adolescents aged 14–18 years, five peer support workers and ten professionals in Kenya, through focus groups, on how their psychosocial needs could be addressed. A thematic codebook framework established three themes on social exclusion, being parented to parent, and relational psychosocial support. These were intersected by negative attitudes toward pregnancy and motherhood across the adolescents’ socioecology. The findings indicate the importance of community awareness, multi-modal interventions, integrated informal and service systems, and active involvement of young mothers with lived experience as peer educators or support workers.

Clinical pharmacists are the principal profession reviewing polypharmacy in English general practice. Pharmacists reviewing polypharmacy can encounter clinical uncertainty, thus affecting decision-making and the utility of medication reviews. Understanding factors and interventions that mitigate clinical uncertainty could improve polypharmacy medication reviews. This review's objective was to explore how primary care clinical pharmacist decision-making can be improved when reviewing polypharmacy in the context of clinical uncertainty. A critical literature review was undertaken in key databases. Included articles explored polypharmacy, clinical uncertainty and medication review by primary care clinical pharmacists. Exclusion criteria included community pharmacy and monotherapy management. Quality assurance was conducted using Lincoln and Guba's evaluative criteria. Contents of included papers were thematically analysed and conceptual models produced. 647 titles/abstracts were screened and 11 full-text articles included, encompassing focus group, interview, ethnography and intervention-development studies. Pharmacists expressed feelings of self-competence occurring alongside apprehension when reviewing polypharmacy. Relationships with patients, including shared decision-making, continuity of care and engagement can support medication reviews. Decision-making is impacted by environmental factors, with poor working relationships within organisations, working across several sites and time pressures hindering deprescribing. The absence of clinical and deprescribing guidelines for multimorbid patients contributes to clinical uncertainty. Multidisciplinary working mitigates clinical uncertainty and training interventions can support pharmacists to proactively deprescribe. Pharmacist, patient and environmental factors can influence pharmacists' decision-making when experiencing clinical uncertainty during polypharmacy review. Clinical education, peer support and multidisciplinary working have roles in reducing clinical uncertainty and therefore optimising pharmacists' reviews of polypharmacy.

IntroductionThis study explored how youth with mental health issues, peer support workers, and primary care professionals perceive youth’s needs while receiving support, key elements of peer support, and its integration into primary healthcare.MethodTwenty-eight semi-structured interviews were conducted and analyzed thematically to identify youth’s needs, core components of peer support, and collaboration challenges between peer support services and primary care.ResultsAll stakeholder groups recognized peer support as a valuable, low-threshold complement to traditional care, particularly for those awaiting treatment or lacking social support. Youth emphasized needs for knowledge, destigmatization, validation and connection - needs specifically addressed by the informal, empathetic, and non-hierarchical nature of peer support. Peer support workers and professionals emphasized the need to balance authenticity with safety and professional boundaries. Effective integration requires structured referral pathways, clear communication channels, confidentiality safeguards, and role clarity. Divergent expectations around responsibility for information sharing and formal requirements on lived experience highlight areas for improvement. Flexible peer support options that match youth's changing needs were seen as essential.DiscussionWhile peer support services offer a valuable addition to youth mental healthcare, its integration with primary care remains complex and requires improved communication, role clarification, and adaptable support options.

Peer support interventions complement traditional rehabilitation services and contribute to improving physical and mental health and community living outcomes in diverse disability populations. Yet, little is known about the impact that being a peer support worker has on people with physical disabilities who take on these roles. Peer health navigators (PHN) are a type of peer support worker specifically trained to help other people with disabilities breakdown barriers to health, healthcare, and social participation. This qualitative study explored identity transformations experienced by people with physical disabilities after adopting a PHN role in a community-based participatory research intervention study. Specifically, we used interpretative phenomenological analysis to explore the lived experiences of peer health navigators from the Our Peers-Empowerment Navigational Support study. Participants identified that serving as a PHN had a transformative impact on their disability experience through relational processes of co-creation of a positive disability identity and reciprocal empowerment. Occupational therapy practitioners can facilitate peer support through intentional skill and community building.

Primary care (general practice) clinics play a significant role in ongoing mental health care and assessment, treatment, and referral of people experiencing distress. Peer support workers (PSWs) are part of the growing Lived Experience workforce in many mental healthcare settings and evidence for their value is growing rapidly. Yet, this workforce is largely absent from primary care. Qualitative interviews with 10 consumers, six family carers, eight PSWs, and 14 general practice doctors, nurses and administrative staff occurred prior to a real-world trial and explored their perceptions of the potential benefits of introducing a PSW intervention for people who seek help for their mental health within primary care in Australia. Interview data were analysed thematically using Braun and Clark's six-step guide, following an inductive approach. Four themes were identified: (1) offering companionship, validation, and hope; (2) sharing learnings and providing practical support; (3) aiding in communication and offering consistency to help address service system gaps and health service navigation; and (4) redistributing power and advocacy. There was strong agreement across interviewees about potential positive impacts that PSWs could have in enhancing mental health care in primary care. These benefits require testing within primary care, given known challenges with awareness and understanding of the PSW role by other health professional disciplines in mental health settings, and differences related to how peer support and primary care practice are delivered. Overall, these perspectives and the existing evidence suggest that peer support may lead to more responsive, safe, effective, and person-centred primary mental health care.

Peer support workers (PSWs) are trained behavioral health professionals with lived experience of substance use disorders. PSWs are employed by behavioral health agencies to increase uptake of and retention in treatment and recovery services. As their presence in these settings grows, it remains unclear how well PSW job functions align with their unique skills and personal experiences. To fill this gap, a content analysis of online job postings for PSW roles in Missouri across geographic regions and types of behavioral healthcare settings (i.e., treatment facilities, recovery housing, recovery community centers, hospitals, criminal justice settings) posted between April 2023 and September 2024 was conducted and analyzed to assess how they reflect role expectations and the distinct value PSWs contribute to the system. Job tasks were organized into categories and classified as authentic (utilizing PSWs' experience and training, e.g., mentoring, recovery goal setting, and peer advocacy) or generic (not specific to peer roles, e.g., administrative duties, transportation, maintaining relationships with external stakeholders). Results showed that PSWs are expected to perform a near even split of authentic (49.8%) and generic (50.2%) tasks. These findings suggest a lack of consistency in how agencies define and implement the PSW role, potentially contributing to job dissatisfaction and turnover. As organizations continue to employ PSWs in greater numbers, it will be important for agencies to prioritize job clarity and satisfaction, as well as determine the optimal balance of tasks for a more consistent system-level understanding of how to best utilize PSWs in the workplace.

Peer support workers (PSWs) play a key role in the substance use disorder (SUD) recovery field. According to organizational support theory, organizational actions and policies are key factors that promote perceived support and positive job-related outcomes. However, limited qualitative research has examined the construct of perceived organizational support from the perspective of PSWs working in the SUD recovery field. This study sought to determine what organizational actions and policies are perceived as supportive for PSWs. Semi-structured qualitative interviews were conducted with 25 PSWs actively working in the recovery field in South Carolina. Participants were asked "How does your employer or organization support you in the work that you do?" and "How could your organization support you better?" Interviews were recorded and transcribed verbatim. A team-based, rapid qualitative analysis approach was used to analyze data. Themes were identified and mapped onto existing guidelines for incorporation of PSWs into addiction medicine settings. PSWs reported that organizations can foster organizational support for PSWs through valuing PSWs as people with lived experiences. PSWs noted important supports such as living wages, insurance, job-related resources, and high-quality training and supervision. In addition, PSWs described how autonomy and reduced workload enable PSWs to optimize their time. Implications for organizations employing PSWs and recommended best practices are discussed.

Mental health peer support is growing as an essential recovery-oriented occupation that can help alleviate the burden of mental health (MH) conditions. Despite its international growth, there is lack of cross-cultural knowledge about peer support workers' (PSW) implementation experiences. This study explored PSWs' implementation experiences of Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) innovativeintervention-a multi-country project designed to empower and scale-up peer support in low-, middle- and high-income countries(LMIC & HIC). Nine focus groups totaling 38 PSWs were conducted at six study sites: Ulm and Hamburg (Germany), Kampala (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Pune (India). Transcripts were analyzed using qualitative analysis and MAXQDA software. Four domains were identified: (i)PSWs' experiences of recovery; (ii)PSWs' experiences of vocational development; (iii)PSWs' experiences with staff and work-role in MH systems;and (iv)PSWs' strive to influence broader circles. In low-and-middle-income countries specifically, PSWs experienced gains for illness management, access to care, employability and financial standing. They also engaged in active interactions with stakeholders in the community (e.g., relatives, police, etc.) promoting social-educative and anti-stigma influences. In high-income countries, experiences related to self-disclosure and peer-vocational development issues. Across sites PSWs' expressed challenges and needs related to lack of role clarity, relations with MH staff and integration into services. The findings reveal the potential of mental health peer support workers (MH PSWs) to aid in mental health recovery and systemic change. However, implementation experiences vary across cultures, highlighting the need to further develop the PSW role and integrate it into mental health systems across different sites. Trial Registration: ISRCTN26008944.

A template for a psychiatric advance directive: Co-development and qualitative evaluation with key stakeholders.

Objectives: This study aimed to provide foundational data for establishing a Korean peer supporter role model by examining current activities and stakeholder perceptions in preparation for the implementation of the Mental Health Promotion and Support for Persons with Mental Disorders Act on January 3, 2026.Methods: A structured survey developed by the research team was administered to 50 peer supporters, 157 psychiatric inpatients, and 50 mental health professionals across Korea. The questionnaire addressed sociodemographic characteristics, awareness of peer supporters, timing of need, role scope, required competencies, collaboration experiences, and institutional improvement needs. Data were analyzed using descriptive statistics.Results: Peer supporters mainly engaged in peer counseling (80.0%), home visits (48.0%), and program facilitation (44.0%). Among inpatients, 49.1% reported limited awareness, yet 74.5% expressed willingness to meet peer supporters, with the highest demand during discharge preparation (mean score: 3.56/5). Mental health professionals cited insufficient competencies (32.0%) and lack of institutional frameworks (24.0%) as barriers, emphasizing role/task standardization (40.0%) and employment stability (30.0%) as priorities for system activation.Conclusion: Successful establishment of the peer supporter system requires clear role definitions (e.g., recovery counselor, recovery coach), expansion of activities to hospitals, communities, and shelters, standardized training and education, and stable employment. These findings can reduce potential confusion before the law’s enforcement and provide evidence for developing peer supporter role guidelines tailored to the Korean context.

BackgroundAutistic women and birthing people (AWBP) face an increased risk of perinatal mental health issues and may be referred to Community Perinatal Mental Health Teams (CPMHTs). However, staff members of CPMHTs often lack sufficient training and knowledge about autism, leading to barriers in providing appropriate care. To date, no studies have examined the experiences of staff supporting autistic women and birthing people within CPMHTs.MethodsWe carried out individual qualitative interviews with 20 staff members from different professional backgrounds across four CPMHTs in England to understand their experiences working with AWBP and to identify how CPMHTs could better meet their needs. Thematic analysis was used to synthesise findings.ResultsWe identified four key themes: (1) recognizing the complexities of AWBP, (2) addressing the unique needs of AWBP (3) varying levels of knowledge and understanding across both the CPMHTs and individual clinicians, and (4) envisioning improvements for the future. Staff reported that working with AWBP was an unexpected aspect of their roles, further complicated by difficulties in accessing autism assessments for those who had not yet received a formal diagnosis. They highlighted both barriers to providing appropriate care and the adjustments they could make to improve their practice. Additionally, staff expressed a need for targeted training and suggested other areas for development, including appointing an autism champion, employing autistic peer support workers, and involving individuals with lived experience of autism and perinatal mental health challenges in co-producing service improvements.ConclusionsWorking with AWBP is a current area of challenge for CPMHTs. Perinatal-focused autism training and expert supervision are important for staff to feel confident in making appropriate adaptions to care to provide the best possible support.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12888-025-07497-6.

Peer support workers (PSWs) are instrumental to engaging individuals with substance use disorder (SUD) in recovery and recovery-based services, yet their unique contributions to engagement are not well documented in the broader literature. This study examined how the engagement strategies of PSWs differ from those in the general mental health services literature across the dimensions of function (i.e., the purpose of the strategy) and form (i.e., the behaviors used to deliver the strategy). Twenty-five PSWs working in South Carolina were interviewed about engagement strategies they employ in their work. Interviews were audio-recorded and transcribed; engagement strategies were identified by the coding team using rapid qualitative analysis. Identified strategies were then compared with strategies from a published literature review on engagement interventions delivered in general mental health services across the dimensions of function and form. PSWs reported two engagement strategies that were different in function and form (Disclosing Lived Experiences, Humanizing the Individual), three strategies that were similar in function but different in form (Expectation Setting, Recovery Capital Building, Rapport Building/Relational Soft Skills), and one strategy that was similar in function and form (Motivational Interviewing/Enhancement) when compared to engagement strategies used in general mental health services. These findings suggest that even when PSWs employ engagement strategies with functions comparable to those used by other professionals, their distinct skillsets, flexibility and lived experience allow them to deliver these strategies in uniquely impactful ways. Implications for workforce development for PSWs and allied professionals serving individuals with SUD are discussed.

IntroductionPeer support workers are individuals with personal lived experience of mental health conditions, addictions, or neurodevelopmental disorders, and can be employed as professionals within mental health services. This study aims to identify predictive factors for patient referral to peer support intervention in psychosocial rehabilitation services.MethodsUsing data from the French REHABase cohort, we compared variables between patients referred (n=134) and not referred (n=242) to peer support intervention. We evaluated an expert-based model (clinician-selected variables) against a machine-based model (algorithm-selected variables) for predictive accuracy.ResultsThe machine-based model outperformed the expert-based model in the full dataset (AUC = 0.78 vs 0.71). However, the predictive performance of both models substantially declined after cross-validation, yielding modest AUC values (0.60 and 0.59), which constitutes a key limitation of the study.DiscussionNeurodevelopmental disorder diagnosis, social isolation, and low treatment adherence predicted peer support referral. Poor model performance may be due to unmeasured factors like patient motivation or clinicians’ perceptions of peer support workers.

COVID-19 saw a rapid shift in how community-based peer support programs were delivered. HIV peer support workers were required to work from home and community-based HIV and LGBTQ + organisations moved their support programs to digital platforms. Between May and September 2020, semi-structured interviews were conducted with individuals who worked (n = 17) or volunteered (n = 4) for community-based HIV and/or LGBTQ + health organisations. Interviews explored the impact of moving to digital service delivery on how peer support programs were delivered and the impact on peer support workers. We identified three overarching themes. Firstly, we highlight challenges with rapidly shifting to online service delivery, particularly as this shift limited opportunities for informal interactions between participants. Informal interactions were considered an important aspect of peer support programs. Secondly, the move to digital service delivery diminished opportunities for informal support between peer workers and their colleagues, just as they were also adjusting to a new and unfamiliar working environment. Thirdly, the removing of physical distance as a specific barrier to care opened new opportunities for engaging potential clients who may have previously had difficulties in accessing HIV support services. We argue that careful consideration is needed to address barriers specific to digital service delivery, including lack of access to appropriate technology and telecommunication infrastructure, as well as concerns about participants' privacy.

BackgroundPeople who are homeless experience an increased prevalence of traumatic events, including childhood trauma, trauma related to being homeless, and structural trauma. It is important to consider trauma in the delivery of health services for this population. Using a trauma-informed care approach is one way to ensure that a service or program takes into consideration the effects of trauma. The aims of this study are to describe how best to design a service to engage people experiencing homelessness in a trauma-focused therapy as well as detail what trauma-informed care would look like in this setting.MethodsWe conducted a series of qualitative interviews about how to design a trauma-informed trauma therapy for people experiencing homelessness and their perspectives on different principles of trauma-informed care. Thematic analysis was used to identify, analyze and report themes identified in the data.ResultsWe conducted 12 in-depth interviews (8 women, 4 men) with people who were currently peer support workers with lived experience of trauma and homelessness. We identified themes to design a trauma-informed service including low-barrier access, communication strategies, meeting people’s needs, and how to engage and retain people in the service. We also identified themes related to how people with lived experience understand the principles of trauma informed care.DiscussionThe findings from this study provide insight and practical recommendations for designing and implementing a trauma-informed therapy tailored for people experiencing homelessness. The findings here shed light on the lived experience perspective of trauma-informed care principles, adding nuance to our understanding of what it means to be trauma-informed.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13428-8.

Peer support is recognised as a promising intervention for people with traumatic brain injury (TBI). Peer support increases belonging, mood and self-acceptance after TBI. In peer support, working alliance is associated with rehabilitation engagement and better health-related outcomes. A better understanding of the working alliance formed between those providing and receiving TBI peer support will inform design considerations for creating peer support networks, including specific considerations for matching peer support workers with peer support receivers. The objectives of this study were to characterise how working alliance is developed through brain injury peer support, and to identify barriers and facilitators of creating peer support networks. This study used a qualitative interpretive description methodology. Semi-structured interviews were conducted with peer support receivers and peer support workers who were involved in a co-designed TBI peer support program, as well as community partners who were involved in the development or implementation of the program. Responses were analysed using reflexive thematic analysis (Objective 1) and inductive content analysis (Objective 2). Nine participants participated in the interviews: three peer support receivers, two peer support workers and four community partners. Three themes describe how working alliance is developed. First, 'feeling understood' explored the importance of validating experiences after TBI. Second, 'expanding conversations beyond injury' highlighted participants' desire to connect on similar life experiences and personal topics other than TBI, such as navigating milestones and life events. Last, 'reciprocal growth' identified how learning occurs between both the peer support receiver and worker. There were four main facilitators of forming a peer support network: characteristics of peer support workers, flexibility in content of sessions, collaboration between researchers and peer support organisations, and formatting of sessions. There were three main barriers to forming a peer support network: irregularity of sessions due to scheduling conflicts, lack of an established peer support program within acute care settings, and lack of resources including space, volunteers and funding. Findings reveal how working alliances between peer support workers and peer support receivers in TBI peer support are facilitated through validation of individual TBI recovery experiences, and mutual growth in the areas of self-acceptance and hope. Successful peer support networks appear to benefit from flexibility and individualisation of format and content of sessions, as well as the creation of collaborations between acute care and community support networks.

ABSTRACTBackgroundWorld Health Organization (WHO) and Thailand's national policy both advocate for recovery‐oriented, community‐based mental healthcare. Village Health Volunteers (VHVs) in Thailand have limited involvement in mental health services despite their pivotal role in Thai primary healthcare, especially in rural settings. This study aims to engage stakeholders to identify and prioritise key areas for VHVs' role expansion, stigma reduction, training needs, and common mental health conditions, thereby enhancing VHVs' contributions to recovery‐oriented mental healthcare in rural Thai communities.MethodsThe study utilised the Nominal Group Technique (NGT). Eight VHVs, six individuals with mental health challenges and caregivers, and four healthcare professionals (HCPs), from three rural sub‐districts in Northern Thailand, were purposively and conveniently recruited. Three NGT groups were formed: in‐person for service providers (VHVs and HCPs) and service users/caregivers, and online for HCPs. Through structured stages of idea generation, sharing, discussion and ranking, participants identified their top five priorities. Ranked priorities were synthesised, and transcripts were analysed using content analysis.ResultsEighteen participants attended one of three NGT groups. Collectively, these groups generated 94 ideas in response to four questions. Four themes were identified: (1) Expansion of VHV's mental health role, including vocational support, family support, emotional support and community reintegration; (2) Stigma reduction, focusing on changing attitudes, implementing a buddy system and enhancing mental health literacy; (3) Training needs including training related to stigma reduction, improving communication skills and providing mental health awareness education; and (4) Common mental health conditions, including psychosis and depression.ConclusionThe prioritisation among the three groups varies. High priorities include vocational support, family support, community reintegration and counselling skills. Addressing stigma is a starting point and can be achieved through increased awareness and literacy. Future research should focus on tailored stigma interventions and trainings to support VHVs in providing effective, recovery‐oriented care in these communities.Patient or Public ContributionSix patient and public involvement (PPI) advisors participated in the study, comprising two VHVs, one mental health nurse, one caregiver and one peer support worker, to ensure research relevance and applicability. The PPI reviewed the Thai NGT questions to assess the appropriateness of language, particularly in relation to mental health and stigma, leading to minor modifications in wording. Additionally, two VHVs and one caregiver assisted in piloting the questions to evaluate their validity and appropriateness and offered feedback on the procedure, content and timing. They recommended using probing questions to elicit more detailed responses and ensuring concise content to maintain participant engagement.

BackgroundPeer support has become a cornerstone of recovery-oriented mental health systems worldwide, with increasing recognition of its value in promoting recovery, empowerment, and inclusion. In Italy, despite a long-standing tradition of community-based care, the integration of peer support services (PSSs) remains fragmented and understudied.MethodsA national cross-sectional online survey was conducted between January and February 2025 targeting all Italian Mental Health Departments (MHDs). The survey explored the presence, organization, and perceived impact of peer support and co-production practices.ResultsA total of 61 out of 135 MHDs (45%) responded. Among them, 55.7% reported implementing peer support initiatives, primarily within community-based services. Peer support workers (PSWs) were generally perceived as effective in fostering recovery and reducing stigma. However, major barriers included lack of formal recognition, insufficient funding, and cultural resistance (e.g., reluctance among some professionals to acknowledge experiential knowledge or to integrate non-clinical roles into multidisciplinary teams). Co-production practices were reported by more than half of the MHDs, though they remained largely consultative.ConclusionsPeer support and co-production are emerging within in Italy’s mental health system but face substantial structural and cultural barriers. National frameworks and dedicated resources are required to support sustainable implementation and the full integration of experiential knowledge into mental health services.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13407-z.

Peer support can enhance the rehabilitation experience for people with traumatic brain injury (TBI). Understanding the feasibility of integrating peer support using a co-design approach can ensure effective delivery. This study aimed to evaluate the feasibility of implementing a community-based peer support program for people with moderate to severe TBI using a co-designed approach. A case series pre-post feasibility study was conducted in partnership with a community brain injury organisation. Participants were adults who experienced a moderate to severe TBI <12months earlier. Feasibility was assessed using process (recruitment and retention rates), resource (adherence to intervention), management (implementation fidelity) and scientific indicators (pre-post intervention changes). Three participants were included, and most measures of feasibility were achieved. Process was achieved with a recruitment rate of 60% (3/5) and a retention rate of 100%. Resource feasibility was achieved with all peer support sessions (100%). Management feasibility was met through the completion of a co-created checklist of session management by peer support workers. Scientific feasibility outcomes showed limited change between pre- and post-intervention. This study demonstrates the feasibility of a co-designed peer support program for people with TBI. Future research may examine the implementation of peer support to explore program scalability and refine outcome measures to better capture the benefits of a peer support focused intervention.